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Pulmonary and Critical Care Division, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11042
Received 13 January 1997; accepted in final form 4 April 1997.
Chen, Ling, and Steven M. Scharf. Comparative
hemodynamic effects of periodic obstructive and simulated central
apneas in sedated pigs. J. Appl.
Physiol. 83(2): 485-494, 1997.
It has been
speculated that because of increased left ventricular (LV) afterload,
decreased intrathoracic pressure (ITP) is responsible for decreased
cardiac output (CO) in obstructive sleep apnea. If this were true, then
obstructive apnea (OA) should have a greater effect on CO than would
central apnea (CA). To assess the importance of decreased
ITP during OA, we studied seven preinstrumented sedated pigs with OA
and simulated CA that were matched for blood gases and apnea
periodicities (with 15- or 30-s apnea duration). Compared with OA, CA
with 30-s apnea duration produced comparable decreases in heart rate
(from baseline to end apnea: OA, 106.6 ± 4.8 to 93.4 ± 4.4 beats/min, P < 0.01; and CA, 111.1 ± 6.2 to 94.0 ± 5.2 beats/min,
P < 0.01) and comparable increases
in LV end-diastolic pressure and LV end-diastolic myocardial segment
length but greater increases in mean arterial pressure (97.1 ± 3.7 to 107.7 ± 4.3 Torr, P < 0.05;
and 97.3 ± 4.8 to 119.3 ± 7.4 Torr,
P < 0.01) and systemic vascular
resistance (2,577 ± 224 to 3,346 ± 400 dyn · s · cm
5,
P < 0.01; and 2,738 ± 294 to
5,111 ± 1,181 dyn · s · cm5,
P < 0.01) and greater decreases in
CO (3.18 ± 0.31 to 2.74 ± 0.26 l/min,
P < 0.05; and 3.07 ± 0.38 to
2.30 ± 0.36 l/min, P < 0.01) and
stroke volume (32.2 ± 2.9 to 25.9 ± 2.4 ml,
P < 0.05; and 31.5 ± 1.9 to 19.8 ± 3.1 ml, P < 0.01). Only CA increased LV end-systolic myocardial
segment length. Similar findings were observed with 15-s apnea
duration. We conclude that CA produced greater depression of CO and
greater changes of afterload-related LV dysfunction than did OA.
Therefore, decreased ITP was not the dominant factor determining LV
function with apneas.
sleep apnea; left ventricular function; hypoxia
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